DHEA: What role in your program?
The arguments for and against
DHEA replacement have zig-zagged from fountain of youth
to dangerous. Here, we cut through the hype and hone in on the
issues
important to your plaque-control program.
“I consider DHEA the superstar of the superhormones. It not only works its wonders inside the body by rejuvenating virtually every organ system, but it actually makes you look, feel, and think better…It restores energy, improves mood, increases sex drive, enhances memory, relieves stress, reduces body fat, and even makes your skin softer and your hair shinier. I think that just about every adult age forty-five or older can benefit from taking DHEA.”
William Regelson, MD
The Super-Hormone Promise
"DHEA is the snake oil of the '90s. It makes me very nervous that people are using a drug we don't know anything about. I won't recommend it."
Elizabeth Barrett-Connor, MD
University of California, San Diego.
Debate on DHEA has polarized proponents and
critics. Comments like those above reveal just how far apart views
on this controversial hormone can be.
Let’s cut through the hype, hyperbole, and hoopla. Don’t believe the
extravagant claims of supplement manufacturers. We also don’t want
to fall victim to the over-conservative medical community’s
reluctance to accept anything that doesn’t require prescription and
come with a fancy dinner provided by a drug representative.
Concerns over the safety of DHEA were raised—and rightly so—in the
1980s and 1990s when multiple clinical trials of “mega-dose” DHEA
(1600–3000 mg per day) led to undesirable hormonal effects: women
experienced masculinizing effects like facial hair and deepened
voices, men became emotional. In other words, at high doses, women
convert DHEA to testosterone, men convert it to estrogen. We
definitely do not want these effects.
More recent experience suggests that, when used at doses that are
“physiologic”, or simply replace diminishing levels due to aging and
restore youthful blood levels to those you had at age 30 or 40, the
hormonal distortions don’t occur. Based on the current state of
knowledge about DHEA, we can expect several potential benefits
through “physiologic replacement”:
- A modest reduction in abdominal and visceral fat results with extended use (6 months or longer).
- A modest improvement in insulin resistance over an extended period (months).
- People feel better taking DHEA, particularly if starting levels are low.
- Men gain greater benefit than women. (Sorry, ladies.)
Along with exaggerated side-effects, outsized benefits also occurred
with mega-dose DHEA, such as dramatic relief of depression,
substantial increases in muscle mass and strength (in men), and
intensified libido in women. These are less prominent at lower
replacement doses.
Does this fascinating hormone possess any benefits for coronary
plaque control? We believe it does. Used intelligently and with
realistic expectations, DHEA can add advantage.
What exactly is DHEA?
Dihydroepiandrosterone, or DHEA, is a hormone produced by the two
adrenal glands in the abdomen, sitting atop the kidneys. Men also
produce up to 25% of total DHEA in their testes. DHEA is distributed
throughout the body and is especially abundant in brain tissue,
blood, kidneys, and liver. For years, DHEA’s precise role has been
debated.
Along with declining muscle mass, bone density, sex hormones, growth
hormone, and increasing body fat, DHEA levels decline starting at
age 30 in men, age 40 in women, with accelerated decline after age
50. By age 70, both men and women have plummeted to 25% of youthful
peak levels (Kroboth PD et al 1999). However, age accounts for only
30% of variation in DHEA blood levels; other factors influence DHEA
levels, as well (Haden ST et al 2000).
It is well established that people with features of the metabolic
syndrome (low HDL, high triglycerides, small LDL, high blood
pressure and blood sugar, excessive abdominal fat) have lower blood
levels of DHEA, probably caused by accelerated clearance (into the
urine) of DHEA induced by high insulin levels (Lavallee B et al
1997), though the association is more prominent in men than in women
(Haffner SM et al 1994). Interestingly, administration of metformin
(Glucophage®) to reduce blood sugar also increases DHEA blood levels
50% or more (Nestler JE et al 1994). . Weight loss also results in a
substantial rise in DHEA blood levels in men (Jakubowicz DJ et al
1995).
Aging, therefore, with its declining DHEA levels, is associated with
increasing levels of insulin resistance, pushing us closer and
closer to metabolic syndrome and pre-diabetes.
By far the most convincing demonstration of DHEA’s potential is in
people (men and women) whose adrenal glands are dysfunctional and
fail to produce its usual panel of hormones (“adrenal
insufficiency”); these people do substantially better with
replacement of hormones if DHEA is included. People feel better, are
less depressed, lose weight, gain muscle, reduce cholesterol, and
reduce blood pressure when DHEA is added (Arlt W et al 1999).
A drug manufacturer has seen sufficient promise in DHEA to pursue
development as a drug. A pharmaceutical-grade preparation
trademarked Prestara™ is in clinical trials for potential use on a
prescription basis for treatment of lupus, and an intravenous form
is under development to treatment acute asthma attacks and burn
injuries.
(We’ve seen this sort of “transformation” before, going from
nutritional supplement status to drug status, accompanied by the
better-funded clinical trials of the drug companies. The most
prominent recent example was fish oil—for many years a nutritional
supplement, then a form “developed” by a drug company that passed
the FDA drug approval process. The drug company then bashes the
nutritional forms on the basis of purity, potency, or other factors
that may or may not be important. We’ll likely see the same
predictable process with DHEA.)
Established benefits of DHEA
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